Pashion

Hello Dave, WOW!!! you were approved quickly...I have called Tricare Prime four times and under the new rules you can have a BMI of 35-39 with one co-morbid but now they also require documentation from your PCM stating that you have tried other weight loss programs or meds that did not work. The surgeon has to write up the request stating that this procedure is for health reasons and not for weight loss (how crazy is that) and that nothing else in the pass has worked. What I thought was strange is that there is nothing in Tricare's policy that says how many months of proof they are requiring and they never mention anything about blood work or having to have an endoscopy done. Why is that I wonder? How did you know that lab work and an endoscopy was needed? Like I said I have called Tricare four times and not once has any Tricare rep mentioned that to me. I wonder if I will be denied stating that I need to have these procedures done first. One other thing I almost forgot to mention. According to Tricare if there is a surgeon at the MTF that is available when the request is submitted and surgery can be done within 30 days Tricare will request that I go to the MTF. They stated that is with any type of procedure because Tricare is military they will always refer to MTF first if possible. Was you BMI over 40?

Thank you. When is your surgery date? Did you need to submit proof that you have tried other weight loss procedures and nothing worked? What reasons did they give you for your previous denials? I am currently waiting for my previous doctor to send my medical records to the surgeon showing my co-morbit then they will sumit it to Tricare Prime for approval. I am currently at 38.6 BMI but my previous doctor was not very attentive so I had to switch to a new doctor who I have only seen twice since Sept. she does not have as much medical history on me as my previous doctor. Some people who have Tricare Prime had to have blood test and and a endoscopy done before Tricare would approve it, did you?

Your message was very helpful thank you so much and good luck with your surgery, I know you will be successful.

I have done my consult with the surgeon and the psych eval, now I am just waiting for orientation on the 17th of this month and a diet class these are required by the surgeon not Tricare. What type of documented trail do I need to have? This is exactly what I am talking about, I called Tricare three times and nobody said anything about having an h pylori, pulmonology or cardiac clearance done. What is h pylori? They did mention having documented weight loss but could not specify what type of weight loss documentation they are looking for and when I asked for how many months they could not tell me that either.

Thank you so much for responding back, sometimes it gets discouraging when you tell people you have Tricare and they look at you as if you are from out of space. Do you know if Tricare will require me go to the MTF instead of my civilian hosptial to have the surgery done. Are you using a MTF or civilian hospital?

Hello All, I am currently two appts away from my paperwork being submitted to Tricare Prime for approval of the lap band. A couple of days ago I was told by the insurance coordinator at the surgeons office (civilian) that Tricare is the hardest insurance company to get approval from and that Tricare has been known to approve the surgery only if the patient has it done at there local MTF. Has this ever happened to anyone? If so please advise? I am here in San Diego and my local MTF is Balboa hospital and they do not have a good reputation so I would prefer not to go there if I do not have to. Thank you

I am glad that you have been approved because I have the same situation my BMI is 38.6 and the nutritionist told me that I would prob be denied because I have to have a BMI of 40 + one co-morbit, but now I see that is not true. One other thing I was also told by the insurance coordinator at the surgeons office that because they are civilian there is a chance that Tricare might come back and say that they will only approval the surgery if I go to my local MTF to have it done. Do you or anyone else reading this knows anything about this?

Hello All, I am new to this forum and I have questions regarding getting approval for the Lap Band by Tricare Prime and I am hoping that someone out there can give me some insite on this because I am starting to get discouraged. My first question is I was told by the nutritionist that because my BMI is 38.6 Tricare will prob deny me. But I thought that as of 03/16/2011 Tricare Prime was approving the lap band if your BMI is 35-40 with one co-morbit. Has anyone with a BMI under 40 been approved by Tricare Prime? My other question is the insurance coordinator at the surgeons office stated that Tricare is the hardest insurance to get approval from and that there is a chance that Tricare will approve me but only if I go to a local MTF for the surgery she explained that this has happened to other Tricare patients in the past. My local MTF is Balboa hospital and I would prefer not to go the there if I didn't have to. Has anyone been approved by Tricare but only if they go to a MTF for the surgery and not to a civilian hospital?